1467697185 NPI number — MRS. MICHELLE AKINS INDERWIES OTR

Table of content: MRS. MICHELLE AKINS INDERWIES OTR (NPI 1467697185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467697185 NPI number — MRS. MICHELLE AKINS INDERWIES OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INDERWIES
Provider First Name:
MICHELLE
Provider Middle Name:
AKINS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AKINS
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
ANGELICA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467697185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
734 FULTON ST
Provider Second Line Business Mailing Address:
APT 2
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11238-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-757-6317
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 W 32ND ST
Provider Second Line Business Practice Location Address:
8TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-564-2350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  006366-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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